Dušan Milisavljević, Ivona Stanković, Jelena Jovanović, Emilija Živković Marinkov, Marija Krstić, Tamara Stanković

DOI Number
First page
Last page


The incidence of hearing loss in patients with rheumatoid arthritis (RA) and the treatment have been differently reported. The aims of this study were to establish the presence and to differentiate the type of hearing loss in patients with RA, and to investigate the results of corticosteroid and methotrexate treatment on hearing loss in RA. Longitudinal, prospective study included 87 patients aged between 18 and 70 years diagnosed with RA. Disease Activity Score (DAS 28 Se) and Health Assessment Questionnaire (HAQ) were measured. 38 Patients were treated with prednisone; intratympanic appliction was used in 11 persons, and in case of weak or absent improvement after steroids methotrexate was applied for further treatment. Predominantly sensorineural hearing loss was present in 56.3% of the patients, without correlation with the duration of disease and clinical activity of RA. Corticosteroid therapy, both peroral or intratympanic contributed to hearing improvement in 60.0%. Audiometric tests are recommended in patients who suffer from RA in order to control hearing in rheumatoid arthritis and analyze the effect of proposed therapeutic procedures.


Rheumatoid arthritis, hearing loss, corticosteroids, methotrexate, intratympanic application

Full Text:



Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO III, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JMW, Hobbs K, Huizinga TWJ, Kavanaugh A, Kay J, Kvien TK, Laing T, Mease P, Ménard HA, Moreland LW, Naden RL, Pincus T, Smolen JS, Stanislawska-Biernat E, Symmons D, Tak PP, Upchurch KS, Vencovský J, Wolfe F, Hawker G. 2010 Rheumatoid Arthritis Classification Criteria. Arthritis Rheum 2010; 62(9):2569–2581

Hajas A, Szodoray P, Barath S, Sipka S, Rezes S, Zeher M, Sziklai I, Szegedi G, Bodolay E. Sensorineural hearing loss in patients with mixed connective tissue disease: immunological markers and cytokine levels. J Rheumatol 2009; 36:1930–1936.

Garcia Callejo FJ, Conill Tobias N, Munoz Fernandez N, de paula Vernetta C, Alonso Castaneita I, Algarra JM. Hearing Impairment in patients with Rheumatoid Arthritis. Acta Otolaryngol Esp 2007; 58:232–238.

Takatsu M, Higaki M, Kinoshita H, Mizushima Y, Koizuka I. Ear involvement in patients with rheumatoid arthritis. Otol Neurotol 2005; 26:755–761.

Buniel MC, Geelan-Hansen K, Weber PC, Tuohy VK. Immunosuppressive therapy for autoimmune inner ear disease. Immunotherapy 2009; 1:425–434.

Matteson EL, Fabry DA, Facer GW, Beatty CW, Driscoll CL, Strome SE, McDonald TJ. Open trial of methotrexate as treatment for autoimmune hearing loss. Arthritis Rheum 2001; 45:146–150.

Harris JP, Weisman MH, Derebery JM, Espeland MA, Gantz BJ, Gulya AJ, Hammerschlag PE, Hannley M, Hughes GB, Moscicki R, Nelson RA, Niparko JK, Rauch SD, Telian SA, Brookhouser PE. Treatment of corticosteroid-responsive autoimmune inner ear disease with methotrexate: A randomized controlled trial. JAMA 2003; 290:1875–1883.

Raut VV, Cullen J, Cathers G. Hearing loss in rheumatoid arthritis. J Otolaryngol 2001; 30:289–294.

Halligan CS, Bauch CD, Brey RH, Achenbach SJ, Bamlet WR, McDonald TJ, Matteson EL. Hearing loss in rheumatoid arthritis. Laryngoscope 2006; 116:2044–2049.

Oztürk A, Yalçin S, Kaygusuz I, Sahin S, Gök U, Karlidağ T, Ardiçoglŭ O. High-frequency hearing loss and middle ear involvement in rheumatoid arthritis. Am J Otolaryngol 2004; 25:411–417.

Bayazit YA, Yilmaz M, Gunduz B, Altinyay S, Kemaloglu YK, Onder M, Gurer MA. Distortion product otoacoustic emission findings in Behçet's disease and rheumatoid arthritis. ORL J Otorhinolaryngol Relat Spec 2007; 69:233–238.

Salvinelli F, D'Ascanio L, Casale M, Vadacca M, Rigon A, Afeltra A. Auditory pathway in rheumatoid arthritis. A comparative study and surgical perspectives. Acta Otolaryngol 2006; 126:32–36.

Dikici O, Muluk NB, Tosun AK, Unlüsoy I. Subjective audiological tests and transient evoked otoacoustic emissions in patients with rheumatoid arthritis: Analysis of the factors affecting hearing levels. Eur Arch Otorhinolaryngol 2009; 266:1719–1726.

Frade C, Martin C. Diagnostic value of the multifrequency tympanometry in active rheumatoid arthritis. Auris Nasus Larynx 1998; 25:131–136.

Milisavljevic D, Stankovic M, Zivic M, Radovanovic Z, Stankovic P. Changes of auditory ossicles in rheumatoid arthritis: scanning electron microscopic study. Eur Arch Otolaryngol 2010; 267:363–366.

Salvinelli F, Cancilleri F, Casale M, Luccarelli V, Di Peco V, D'Ascanio L, De Martino A, Denaro V. Hearing thresholds in patients affected by rheumatoid arthritis. Clin Otolaryngol Allied Sci 2004; 29:7579.

Dayal VS, Ellman M, Sweiss N. Autoimmune inner ear disease: Clinical and laboratory findings and treatment outcome. J Otolaryngol Head Neck Surg 2008; 37:591–596.

Quesnel S, Nguyen Y, Elmaleh M, Grayeli AB, Ferrary E, Sterkers O, Couloigner V. Effects of systemic administration of methylprednisolone on residual hearing in an animal model of cochlear implantation. Acta Otolaryngol 2011; 131:579–584.

Trune DR, Kempton JB, Harrison AR, Wobig JL. Glucocorticoid impact on cochlear function and systemic side effects in autoimmune C3.MRL-Faslpr and normal C3H/HeJ mice. Hear Res 2007; 226:209–217.

Sismanis A, Wise CM, Johnson GD. Methotrexate management of immune-mediated cochleovestibular disorders. Otolaryngol Head Neck Surg 1997; 116:146–152.

Inoue Y, Tomemori T, Suzuki S, Arima T, Tomiita M, Shimojo N, Kohno Y. Low-dose oral methotrexate for the management of childhood Cogan's syndrome: A case report. Clin Rheumatol 2007; 26:2201–2203.

Lobo D, Trinidad A, García-Berrocal JR, Verdaguer JM, Ramírez-Camacho R. TNFalpha blockers do not improve the hearing recovery obtained with glucocorticoid therapy in an autoimmune experimental labyrinthitis. Eur Arch Otorhinolaryngol 2006; 263:622–626.

Matteson EL, Choi HK, Poe DS, Wise C, Lowe VJ, McDonald TJ, Rahman MU. Etanercept therapy for immune-mediated cochleovestibular disorders: A multi-center, open-label, pilot study. Arthritis Rheum 2005; 53:337-342.

Morovic Vergles J, Radic M, Kovacic J, Salamon L. Successful use of adalimumab for treating rheumatoid arthritis with autoimmune sensorineural hearing loss: Two birds with one stone. J Rheumatol 2010; 37:1080–1081.

Parnes LS, Sun AH, Freeman DJ. Corticosteroid pharmacokinetics in the inner ear fluids: An animal study followed by clinical application. Laryngoscope 1999; 109:1–17.

García-Berrocal JR, Ibáñez A, Rodríguez A, González-García JA, Verdaguer JM, Trinidad A, Ramírez-Camacho R. Alternatives to systemic steroid therapy for refractory immune-mediated inner ear disease: A physiopathologic approach. Eur Arch Otorhinolaryngol 2006; 263:977–982.

Oude Voshaar MA, Ten Klooster PM, Taal E, van de Laar MA. Measurement properties of physical function scales validated for use in patients with rheumatoid arthritis: A systematic review of the literature. Health Qual Life Outcomes 2011; 9:99.

Garip Y, Eser F, Bodur H. Health-related quality of life in rheumatoid arthritis: Comparison of RAQoL with other scales in terms of disease activity, severity of pain, and functional status. Rheumatol Int 2011; 31:769–772.

Linde L, Sørensen J, Ostergaard M, Hørslev-Petersen K, Hetland ML. Health-related quality of life: validity, reliability, and responsiveness of SF-36, 15D, EQ-5D [corrected] RAQoL, and HAQ in patients with rheumatoid arthritis. J Rheumatol 2008; 35:1528–1537.

Dougados M, Ripert M, Hilliquin P, Fardellone P, Brocq O, Brault Y, Logeart I. The Influence of the definition of patient global assessment in assessment of disease activity according to the Disease Activity Score (DAS28) in rheumatoid arthritis. J Rheumatol 2011; 38:2326–2328.

DOI: https://doi.org/10.22190/FUMB161005004M


  • There are currently no refbacks.

© University of Niš, Serbia
Creative Commons licence CC BY-NC-ND
ISSN 0354-4699 (Print)
ISSN 2406-050X (Online)